Intracapsular Tonsillectomy Associated With Reduced Postoperative Pain

Patients who have a tonsillectomy that spares the tonsil capsule appear to have less postoperative heavy bleeding and pain compared with those who undergo traditional tonsil removal surgery, according to a new report.

Researchers at the Alfred I. duPont Hospital for Children (Wilmington, DE, USA) analyzed the medical records of 2,944 patients who underwent tonsillectomy with or without adenoidectomy between 2002 and 2005. For 1,731 patients, surgeons used a newer technique known as intracapsular tonsillectomy, which involves using an instrument known as a microdebrider to remove 90% of the tonsil tissue and preserving a layer of tonsil (the capsule) over the throat muscles. A total of 1,212 underwent traditional tonsillectomy, in which all tonsil tissue is cut and removed.

The study found that among those in the traditional tonsillectomy group, 3.4% had delayed hemorrhage and 2.1% required treatment in the operating room for bleeding, compared with 1.1% and 0.5% respectively among those in the intracapsular tonsillectomy group. Among those who underwent intracapsular tonsillectomy, 3% required emergency room treatment for pain or dehydration, compared to 5.4% of those undergoing traditional tonsillectomy. The study was published in the September 2007 issue of Archives of Otolaryngology - Head & Neck Surgery.

"Although the risks for intracapsular tonsillectomy are lower than those for traditional tonsillectomy, the procedure is not always effective,” cautioned lead author Richard Schmidt, M.D., and colleagues. "Eleven patients required revision tonsillectomy in the intracapsular tonsillectomy group compared with none in the traditional tonsillectomy group. However, an additional surgical procedure (including control of hemorrhage in the operating room) may be more likely with traditional tonsillectomy than with intracapsular tonsillectomy.”

Tonsillectomy with or without removal of the adenoids is one of the most commonly performed surgeries, even though a significant reduction in the number of tonsillectomies has occurred over the last two decades. This has been due in part to more stringent guidelines for tonsillectomy and adenoidectomy, and an ongoing debate about the usefulness of tonsillectomies in general.


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